Question 1
A 55-year-old male with a history of type 2 diabetes mellitus (T2DM) for 10 years, hypertension, and hyperlipidemia is seen for a follow-up visit. He reports his blood glucose levels have been higher than usual. His current medications include metformin 1000 mg twice daily, lisinopril 20 mg daily, and atorvastatin 40 mg daily. His recent HbA1c is 8.5%. The patient is interested in adding a medication that could also benefit his cardiovascular health. Which of the following medications would be most appropriate to add to this patient’s regimen?
A. Glipizide B. Pioglitazone C. Empagliflozin D. Acarbose E. Regular insulin
Rationale: The drug, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been shown to offer cardiovascular benefits in patients with T2DM, including reducing the risk of cardiovascular death and hospitalization for heart failure. Glipizide (a sulfonylurea) and acarbose (an alpha-glucosidase inhibitor) primarily lower blood glucose without direct cardiovascular benefits. Pioglitazone (a thiazolidinedione) can improve some markers of cardiovascular risk but is primarily not indicated for cardiovascular benefit and has concerns regarding fluid retention. Regular insulin is effective for glucose control but does not offer specific cardiovascular benefits.
Question 2
A 42-year-old female with T2DM is being reviewed for medication optimization. She has a BMI of 35 kg/m² and is currently taking metformin 850 mg three times a day. Despite her efforts with diet and exercise, her HbA1c remains at 7.8%. She is interested in a medication that could also aid in weight loss. Which of the following medications should be added to the patient’s diabetes regimen?
A. Nateglinide B. Rosiglitazone C. Liraglutide D. Glyburide E. Sitagliptin
Rationale: The drug, a glucagon-like peptide-1 (GLP-1) receptor agonist, not only improves glycemic control but also promotes weight loss, making it a suitable choice for this patient who has a high BMI and is looking to lose weight. Nateglinide and glyburide (sulfonylureas) tend to cause weight gain. Rosiglitazone (a thiazolidinedione) can lead to weight gain and fluid retention. Sitagliptin (a dipeptidyl peptidase-4 inhibitor) is weight-neutral and would not aid in weight loss.
Question 3
A 60-year-old male with T2DM is on metformin 1000 mg twice daily. His current HbA1c is 7.4%. He reports frequent episodes of hypoglycemia. He has no history of cardiovascular disease but is interested in a medication that would not increase his risk of hypoglycemia. Which of the following would be the most appropriate addition to his diabetes regimen?
A. Dapagliflozin B. Glibenclamide C. Insulin glargine D. Repaglinide E. Pioglitazone
Rationale: The drug, an SGLT2 inhibitor, lowers blood glucose with a low risk of hypoglycemia and is suitable for patients concerned about hypoglycemic episodes. Insulin glargine and glibenclamide (a sulfonylurea) have higher risks of hypoglycemia. Repaglinide, a meglitinide, also carries a significant risk of hypoglycemia, especially if meals are skipped. Pioglitazone may have a lower risk of hypoglycemia but does not directly address the patient’s concern regarding hypoglycemia and has other side effects such as weight gain and fluid retention.
Question 4
A 50-year-old woman with T2DM currently takes metformin and a daily multivitamin. She reports gastrointestinal (GI) distress attributed to metformin. Her physician decides to prescribe a medication with a minimal risk of GI side effects. Her HbA1c is 7.5%. Which of the following medications would be most appropriate to add?
A. Empagliflozin B. Exenatide C. Glipizide D. Acarbose E. Sitagliptin
Rationale: The drug, an SGLT2 inhibitor, is less likely to cause GI side effects compared to other classes of antidiabetics and can be a suitable addition for patients experiencing GI distress with metformin. Exenatide, a GLP-1 receptor agonist, often causes GI side effects such as nausea and vomiting. Glipizide, a sulfonylurea, has a lower risk of GI side effects but does not specifically address this concern as effectively as empagliflozin. Acarbose, an alpha-glucosidase inhibitor, is known to cause significant GI side effects, including flatulence and diarrhea. Sitagliptin, a DPP-4 inhibitor, has a minimal risk of GI side effects but is not as favorably recommended for GI concerns as SGLT2 inhibitors.
Question 5
A 67-year-old male with a history of T2DM, chronic kidney disease (stage 3), and hypertension is being reviewed for medication adjustment. His current diabetes regimen includes glipizide and metformin. Given his renal status, which of the following medications would be most appropriate to consider adding?
A. Canagliflozin B. Saxagliptin C. Dulaglutide D. Glyburide E. Rosiglitazone
Rationale: The drug, a GLP-1 receptor agonist, can be used safely in patients with chronic kidney disease (CKD) and provides effective glycemic control without significant renal dose adjustment concerns. Canagliflozin, an SGLT2 inhibitor, requires caution and often adjustment or avoidance in advanced CKD. Saxagliptin, a DPP-4 inhibitor, requires dose adjustment based on renal function. Glyburide, a sulfonylurea, is not recommended in patients with renal impairment due to the increased risk of hypoglycemia. Rosiglitazone, a thiazolidinedione, does not have specific renal dosing concerns but is not the most appropriate choice given the patient’s CKD and potential for fluid retention.
Question 6
A 58-year-old female with T2DM and a history of cardiovascular disease is being evaluated for medication optimization. Her current regimen includes metformin and simvastatin. She reports adherence to her medications and lifestyle modifications, but her latest HbA1c is 8.1%. The healthcare provider is considering adding a medication that has demonstrated cardiovascular benefits. Which of the following medications should be added to the patient’s treatment plan?
A. Semaglutide B. Urapidil C. Glimepiride D. Miglitol E. Rosiglitazone
Rationale: The drug, a GLP-1 receptor agonist, has been shown to provide cardiovascular benefits, including reducing the risk of major adverse cardiovascular events in patients with type 2 diabetes and established cardiovascular disease. This makes it an appropriate choice for a patient with T2DM and a history of cardiovascular disease. Urapidil is an antihypertensive agent and not used in diabetes management. Glimepiride, a sulfonylurea, may increase the risk of hypoglycemia without offering cardiovascular benefits. Miglitol, an alpha-glucosidase inhibitor, and rosiglitazone, a thiazolidinedione, do not have the cardiovascular benefits seen with GLP-1 receptor agonists.
Question 7
A 45-year-old male with T2DM is seen in the clinic. His current medications include metformin 500 mg twice daily and sitagliptin 100 mg daily. Despite adherence to medication and lifestyle changes, his HbA1c remains at 7.9%. He has no history of cardiovascular disease and prefers to avoid injections if possible. Which oral medication would be most appropriate to add to his current regimen?
A. Linagliptin B. Canagliflozin C. Glipizide D. Pioglitazone E. Acarbose
Rationale: The drug, an SGLT2 inhibitor, is an oral medication that can effectively lower HbA1c levels and offers benefits such as weight loss and blood pressure reduction, making it a suitable addition to this patient’s regimen. Linagliptin, another DPP-4 inhibitor, would not be added to a regimen that already includes sitagliptin, as they are from the same drug class. Glipizide, a sulfonylurea, could cause hypoglycemia and weight gain, which are less desirable. Pioglitazone can cause weight gain and fluid retention, while acarbose, an alpha-glucosidase inhibitor, is less effective in lowering HbA1c compared to other options and can cause gastrointestinal side effects.
Question 8
A 52-year-old female with T2DM, obesity, and nonalcoholic steatohepatitis (NASH) is considering additional therapy to her current regimen of metformin. Her HbA1c is 7.6%. She is seeking a treatment option that may also have a beneficial effect on her liver condition. Which of the following medications would be most appropriate to add?
A. Pioglitazone B. Glibenclamide C. Exenatide D. Sitagliptin E. Empagliflozin
Rationale: The drug, a thiazolidinedione, has been shown to have beneficial effects on NASH and insulin sensitivity, making it a suitable choice for this patient. While it may cause weight gain, its potential benefits for NASH could outweigh this risk in this specific scenario. Glibenclamide, a sulfonylurea, could increase the risk of hypoglycemia without providing benefits for NASH. Exenatide, a GLP-1 receptor agonist, and empagliflozin, an SGLT2 inhibitor, may aid in weight management but have not been specifically recommended for NASH improvement. Sitagliptin, a DPP-4 inhibitor, is generally considered neutral in terms of effects on liver fat content.
Question 9
A 70-year-old male with T2DM and chronic heart failure is reviewing his medication regimen. His current diabetes medications include metformin and saxagliptin. Given his history of heart failure, the healthcare provider is considering adding a medication that has demonstrated benefits in patients with heart failure. Which of the following medications would be most appropriate to add?
A. Dapagliflozin B. Glipizide C. Repaglinide D. Nateglinide E. Acarbose
Rationale: The drug, an SGLT2 inhibitor, has been shown to offer significant benefits for patients with T2DM and heart failure, including reducing hospitalizations for heart failure and cardiovascular death. This makes it a particularly suitable option for this patient. Glipizide, repaglinide, and nateglinide, all insulin secretagogues, do not provide these specific heart failure benefits and can cause weight gain and hypoglycemia, which are undesirable in heart failure patients. Acarbose, an alpha-glucosidase inhibitor, primarily affects postprandial blood glucose and does not offer benefits for heart failure.
Question 10
A 38-year-old female with T2DM and a history of gestational diabetes during her last pregnancy is seeking medication adjustment. She is planning to become pregnant again and is currently on metformin 1000 mg twice daily and glipizide 10 mg daily. Considering her pregnancy plans, which medication adjustment is most appropriate? Which of the following actions should be taken regarding her medication regimen?
A. Discontinue glipizide and continue metformin. B. Add exenatide to her current regimen. C. Switch from glipizide to dapagliflozin. D. Discontinue metformin and start insulin. E. Continue both metformin and glipizide without changes.
Rationale: The drug is the standard of care for managing diabetes in pregnancy due to its safety profile and effectiveness in controlling blood glucose levels without crossing the placenta. While metformin and glyburide have been used in gestational diabetes, insulin is preferred, especially for pre-pregnancy planning and during pregnancy to ensure optimal glycemic control. Exenatide and dapagliflozin are not recommended during pregnancy due to insufficient data on safety. Continuing both metformin and glipizide without changes would not be advisable due to the risks associated with oral antidiabetics during pregnancy and the superior safety profile of insulin in this setting.